Developing Tailored Messages to Improve Mental Health and Adjustment of Asian International Students
Keywords:Asian international students, mental health, adjustment, tailored messages, intervention development
The purpose of the study was to develop tailored messages improving mental health and adjustment of Asian international students (AIS) in the US. The PEN-3 cultural model was used to contextualize the role of culture in mental health needs of AIS. Messages were developed through a multi-step participatory process with consisting of three focus groups (n=15), thirteen individual interviews, one expert consultation, and finally an online survey (n=85). The study led to the development of seven broad themes with seven tailored messages under each theme (total 49). Seven broad themes were: increasing the awareness of mental health and reducing stigma; motivational quotes; available and accessible resources for AIS to improve mental health; seeking help from social network and developing interpersonal skills; adjusting to American culture and college life; coping strategies to reduce stress and improve mental health and adjustment; and safety issues. The implications for culturally responsive programs are discussed.
Agyapong, V. I., Mrklas, K., Suen, V. Y., Rose, M. S., Jahn, M., Gladue, I., Kozak, J., Leslie, M., Dursun, S., Ohinmaa, A., & Greenshaw, A. (2015). Supportive text messages to reduce mood symptoms and problem drinking in patients with primary depression or alcohol use disorder: protocol for an implementation research study. JMIR Research Protocols, 4(2), e55. https://doi.org/10.2196/resprot.4371
Airhihenbuwa, C. O. (1990). A conceptual model for culturally appropriate health education programs in developing countries. International Quarterly of Community Health Education, 11(1), 53–62. https://doi.org/10.2190/LPKH-PMPJ-DBW9-FP6X
Bramley, D.M., Riddell, T., Whittaker, R., Corbett, T., Lin, R., Wills, M.J., Jones, M., & Rodgers, A. (2005). Smoking cessation using mobile phone text messaging is as effective in Maori as non-Maori. The New Zealand Medical Journal, 118(1216), U1494.
Chen, S. X., Mak, W. W. S., & Lam, B. C. P. (2020). Is it cultural context or cultural value? Unpackaging cultural influences on stigma toward mental illness and barrier to help-seeking. Social Psychological and Personality Science, 11(7), 1022–1031. https://doi.org/10.1177/1948550619897482
Dobson, R., Whittaker, R., Bartley, H., Connor, A., Chen, R., Ross, M., & McCool, J. (2017). Development of a culturally tailored text message maternal health program: TextMATCH. JMIR mHealth and uHealth, 5(4), e49. https://doi.org/10.2196/mhealth.7205
Fisher, T. L., Burnet, D. L., Huang, E. S., Chin, M. H., & Cagney, K. A. (2007). Cultural leverage: interventions using culture to narrow racial disparities in health care. Medical care research and review: MCRR, 64(5 Suppl), 243S–82S. https://doi.org/10.1177/1077558707305414
Garland, A. F., Lau, A. S., Yeh, M., McCabe, K. M., Hough, R. L., & Landsverk, J. A. (2005). Racial and ethnic differences in utilization of mental health services among high-risk youths. American Journal of Psychiatry, 162(7), 1336–1343. https://doi.org/10.1176/appi.ajp.162.7.1336
Gustafson, D. H., McTavish, F. M., Chih, M. Y., Atwood, A. K., Johnson, R. A., Boyle, M. G., Levy, M. S., Driscoll, H., Chisholm, S. M., Dillenburg, L., Isham, A., & Shah, D. (2014). A smartphone application to support recovery from alcoholism: a randomized clinical trial. JAMA Psychiatry, 71(5), 566–572. https://doi.org/10.1001/jamapsychiatry.2013.4642
Han, X., Han, X., Luo, Q., Jacobs, S., & Jean-Baptiste, M. (2013). Report of a mental health survey among Chinese international students at Yale University. Journal of American College Health, 61(1), 1–8. https://doi.org/10.1080/07448481.2012.738267
Han, S., Pistole, M.C., & Caldwell, J.M. (2017). Acculturative stress, parental and professor attachment, and college adjustment in Asian international students. Journal of Multicultural Counseling and Development, 45, 111-126. https://doi.org/10.1002/jmcd.12068
Hawkins, R. P., Kreuter, M., Resnicow, K., Fishbein, M., & Dijkstra, A. (2008). Understanding tailoring in communicating about health. Health Education Research, 23(3), 454–466. https://doi.org/10.1093/her/cyn004
Hofstede, G. (2011). Dimensionalizing cultures: The Hofstede model in context. Online Readings in Psychology and Culture, Unit 2. Retrieved from http://scholarworks.gvsu.edu/orpc/vol2/iss1/8
Institute of International Education (IIE). Research & insights: Open doors. Retrieved from https://www.iie.org/Research-and-Insights/Open-Doors
Johnson, L. R., Seifen-Adkins, T., Singh Sandhu, D., Arbles, N., & Makino, H. (2018). Developing culturally responsive programs to promote international student adjustment: a participatory approach. Journal of International Students, 8(4), 1865–1878. https://doi.org/10.32674/jis.v8i4.235
Kreuter, M. W., Oswald, D. L., Bull, F. C., & Clark, E. M. (2000). Are tailored health education materials always more effective than non-tailored materials? Health Education Research, 15(3), 305–315. https://doi.org/10.1093/her/15.3.305
Kreuter, M. W., & Wray, R. J. (2003). Tailored and targeted health communication: strategies for enhancing information relevance. American Journal of Health Behavior, 27 Suppl 3, S227–S232. https://doi.org/10.5993/ajhb.27.1.s3.6
Liu, H., Wong, Y. J., Mitts, N. G., Li, P. J., & Cheng, J. (2020). A phenomenological study of East Asian international students’ experience of counseling. International Journal for the Advancement of Counselling, 42(3), 269-291. https://doi.org/10.1007/s10447-020-09399-6
Lustria, M. L. A., Noar, S. M., Cortese, J., Van Stee, S. K., Glueckauf, R. L., & Lee, J. (2013). A meta-analysis of web-delivered tailored health behavior change interventions. Journal of Health Communication, 18(9), 1039–1069. https://doi.org/10.1080/10810730.2013.768727
Ma, K., Pitner, R., Sakamoto, I., & Park, H. Y. (2020). Challenges in Acculturation among International Students from Asian Collectivist Cultures. Higher Education Studies, 10(3), 34-43.
Marcus, A. C., Mason, M., Wolfe, P., Rimer, B. K., Lipkus, I., Strecher, V., Warneke, R., Morra, M. E., Allen, A. R., Davis, S. W., Gaier, A., Graves, C., Julesberg, K., Nguyen, L., Perocchia, R., Speyer, J. B., Wagner, D., Thomsen, C., & Bright, M. A. (2005). The efficacy of tailored print materials in promoting colorectal cancer screening: results from a randomized trial involving callers to the National Cancer Institute's Cancer Information Service. Journal of Health Communication, 10 Suppl 1, 83–104. https://doi.org/10.1080/10810730500257754
Mikal, J. P., Yang, J., & Lewis, A. (2015). Surfing USA: how internet use prior to and during study abroad affects Chinese students’ stress, integration, and cultural learning while in the United States. Journal of Studies in International Education, 19(3), 203–224. https://doi.org/10.1177/1028315314536990
Morrison, F. P., Kukafka, R., & Johnson, S. B. (2005). Analyzing the structure and content of public health messages. AMIA ... Annual Symposium proceedings. AMIA Symposium, 2005, 540–544.
Nimmon, L., Poureslami, I., & FitzGerald, J. M. (2012). What counts as cultural competency in telehealth interventions? A call for new directions. Journal of Telemedicine and Telecare, 18(7), 425–426. https://doi.org/10.1258/jtt.2012.120517
Noar, S. M., Grant Harrington, N., Van Stee, S. K., & Shemanski Aldrich, R. (2011). Tailored health communication to change lifestyle behaviors. American Journal of Lifestyle Medicine, 5(2), 112–122. https://doi.org/10.1177/1559827610387255
Petty, R. E., & Cacioppo, J. T. (1979). Issue involvement can increase or decrease persuasion by enhancing message-relevant cognitive responses. Journal of Personality and Social Psychology, 37(10), 1915-1926. https://doi.org/10.1037/0022-35188.8.131.525
Ra, Y.A. & Trusty, J. (2017). Impact of social support and coping on acculturation and acculturative stress of East Asian international students. Journal of Multicultural Counseling and Development, 45, 276-291. https://doi.org/10.1002/jmcd.12078
Rimer, B. K., & Kreuter, M. W. (2006). Advancing tailored health communication: A persuasion and message effects perspective. Journal of Communication, 56, S184-S201. https://doi.org/10.1111/j.1460-2466.2006.00289.x
Ruzek, N. A., Nguyen, D. Q., & Herzog, D. C. (2011). Acculturation, enculturation, psychological distress and help-seeking preferences among Asian American college students. Asian American Journal of Psychology, 2(3), 181-196. https://doi.org/10.1037/a0024302
Smeets, T., Brug, J., & de Vries, H. (2006). Effects of tailoring health messages on physical activity. Health Education Research, 23(3), 402–413. https://doi.org/10.1093/her/cyl101
Strecher, V. J., Kreuter, M., Den Boer, D.-J., Kobrin, S., Hospers, H. J., & Skinner, C. S. (1994). The effects of computer-tailored smoking cessation messages in family practice settings. Journal of Family Practice, 39(3), 262–270.
Triandis, H. C. (1995). Individualism & collectivism. Westview Press
Updegraff, J. A., Sherman, D. K., Luyster, F. S., & Mann, T. L. (2007). The effects of message quality and congruency on perceptions of tailored health communications. Journal of Experimental Social Psychology, 43(2), 249–257. https://doi.org/10.1016/j.jesp.2006.01.007
Wei, J., Hollin, I., & Kachnowski, S. (2011). A review of the use of mobile phone text messaging in clinical and healthy behaviour interventions. Journal of Telemedicine and Telecare, 17(1), 41–48. https://doi.org/10.1258/jtt.2010.100322
Williams-Piehota, P., Schneider, T. R., Pizarro, J., Mowad, L., & Salovey, P. (2003). Matching health messages to information-processing styles: Need for cognition and mammography utilization. Health Communication, 15(4), 375–392. https://doi.org/10.1207/S15327027HC1504_01
Wong, Y. J., Wang, K. T., & Maffini, C. S. (2014). Asian international students’ mental health related outcomes: A person context cultural framework. The Counseling Psychologist, 42, 278–305. http://dx.doi.org/10.1177/0011000013482592
How to Cite
Copyright (c) 2021 Journal of International Students
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
All published articles are licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 4.0 Unported License.